Acute psychiatric hospital project- new ideas to implement for our facility
Thank you for taking on this project. Let me give you some background about our hospital. We are an acute psychiatric hospital. No medical treatment, just psych. We have 63 beds. Our hospital is locked and so most patients are there against their will. Our population consists of patients that admitted to the hospital on 72 hour, involuntary holds(5150) for being a danger to them self, danger to others, or gravely disabled. Our demographic is ages 18 and above, mostly Kaiser members but about 10% people with no insurance or medi-cal insurance. The majority of patients have diagnoses of Depression, Psychotic Disorders (Schizophrenia), or Bipolar Disorder. Our patient have suicidal thoughts and or homicidal thoughts, They can be aggressive and impulsive, they can be depressed and mute, and anxious. Also, we have a few people with dementia or cognitive disorders. About 10% of our patients are homeless. Our clinical staffing consists of Psychiatrists, nurses, nurse practitioners, an internist, social works, case managers, recreational therapists, dietician, and pharmacists. The social works, recreational therapists(rehab), dietician, and pharmacists all run groups. Your focus is rehab. Currently, Rehab’s role is to provide recreational therapy and leisure activities to the patients: exercise, ADL’s (activities and daily living), art and music therapy, relaxation and meditation, games, karaoke, arts and crafts, etc. Right now the rehab department has 3 groups a day: exercise group, education group, and leisure group. But often patients are not interested in attending, the groups are boring, the rec therapist plays a board game and it simply isn’t stimulating the patient nor contributing to alleviation of symptoms. We need to incorporate the latest interventions into our groups. Our project is to look at the daily schedule of groups and activities for the patients and revamp it as our groups have been the same probably for 15 years. We want to develop a program that is fresh, innovative and up to speed with the community standard. We want to know what type of groups research supports for an acute setting, as well as what other psychiatric hospitals or units are offering to their patients. We want to look at the role of the Recreational therapist, consider their training and background and determine their capabilities because I don’t think we are using them to their potential. Additionally we want to bring activity aides aboard to assist with the groups. We want to find out what groups can we have that will interest the patients enough to want to attend, get them up and moving to alleviate their depression and anxiety, get them communicating and socializing with peers. There are some things to consider. Being that we are a Psychiatric hospital, there are strict guidelines of what devises or equipment we can use with the patients. For example, We can’t have anything that can be used as a weapon, nothing with strings or cords, no scissors or sharp objects, even staples and paper clips cannot be on any paper work given to the patients. We don’t use pens on the unit, just markers and small pencils that after use need to be collected and accounted for. Heavy balls are a concern if they are heavy enough to knock someone out, where as something soft as a beach ball seems appropriate. We can talk more about various restrictions we have regarding safety. Basically we need the recent research that tells us things like what type of groups we should have, the structure of them, who should lead them, what can be safely used on a locked psychiatric unit.
